Telangiectasia... Treatable Trouble

You have seen them as you peer through your magnifier, a series of fine red, blue, or purple lines that look like a map of little rivers across your client’s face. These are not broken capillaries as so many of us call them; they are, in fact, telangiectasia. Telangiectasias are not broken, but very small, dilated blood vessels approximately .5 to 1 mm in diameter. They are found near the surface of the skin or mucous membranes and while we often see them on the face near the nose, cheeks, or chin they can develop on the chest, the upper thigh, below the knee joint, and around the ankles. Often the telangiectasias on legs are referred to as “spider veins”. As an electrologist, you will encounter these tiny veins on the face and legs of your clients. It is important that you understand what these are, what can cause them, whether or not you can treat the area in which you find them, and if you can treat the veins with the needle.

The causes of telangiectasia can be congenital (inherited) or acquired. Let us briefly look at the inherited causes first. The most recognizable congenital condition is the naevus flammeus, also known as port-wine stain. Other diseases or syndromes involving dilated blood vessels or venous abnormalities that can occur, including Maffucci’s syndrome. Many of these congenital diseases can affect several areas of the body including the brain and organs and can be debilitating.

The acquired causes of telangiectasia are more common and usually the versions we see in our practice. Spider veins found in the legs can be caused by age, starting between ages 18 to 35 and peaking around 50 to 60 years of age. Women are four times more likely to develop spider veins than men. Pregnancy is a key factor contributing to the formation of spider veins. Those that form during pregnancy may spontaneously improve or even disappear a few months after delivery. People who are involved with prolonged sitting or standing in their daily activities or jobs, have an increased risk of developing spider veins. The weight of the blood continuously pressing against the closed valves causes them to fail.

Telangiectasia found on the face can be caused by rosacea, environmental damage from sun or cold exposure, chemotherapy and radiation exposure experienced during cancer treatments, long term use of topical corticosteroids, and cirrhosis of the liver. Estrogen, either natural or in the form of oral contraceptives, can cause the blood vessels to enlarge and multiply. Similarly, alcohol causes this to happen by adversely affecting the liver’s ability to detoxify the body’s natural estrogen levels.

Treatment of telangiectasia and spider veins by physicians has typically been sclerotherapy. Sclerotherapy is a medication, usually in foam form, that is injected into the veins so they harden and eventually shrink. Sclerotherapy was used as far back as 1682 when a doctor in Switzerland injected an acid into veins. Since 1853, there have been several different and more effective methods of this procedure though many were abandoned over time due to the severe side effects of the drugs used. All of these methods culminated in today’s method of using a “toothpaste consistency” foam product made from sclerosant drugs, which are mixed with air or a physiological gas in a syringe. The foam sclerosant increases the surface area of the drug in the veins and does not mix with blood in the vessel, which can dilute the liquid versions.

Injecting the unwanted veins with this solution causes the target vein to immediately shrink, and then dissolve over a period of weeks as the body naturally absorbs the treated vein. Sclerotherapy is the "gold standard" and is preferred over laser for eliminating large telangiectasia and smaller varicose leg veins. Unlike a laser, the solution additionally closes the "feeder veins" under the skin that are causing the telangiectasia to form, thus making a recurrence of the telangiectasia in the treated area less likely. Multiple injections of solution are injected into the abnormal surface veins of the involved leg. The client's leg is then compressed with either stockings or bandages that they wear usually for two weeks post-treatment. Clients are also encouraged to walk regularly during that time. It is common practice for the client to require at least two treatment sessions separated by several weeks to significantly improve the appearance of the veins.

Though this method is popular and effective there may be side effects. Bruising may occur and last for some time. If the physician should miss a vein and inject the solution directly into the skin then “injection necrosis” may result. These can be small ulcer-like lesions that may take a long time to heal and usually leave a scar. There also may be deposits from the mixture of blood and solution that may cause a yellow-brown discoloration down the entire length of the vein being injected. Clients may be trading unsightly little red veins for brown ones!

So, can we treat telangiectasia? The answer is “maybe.” Always check with your state’s individual laws pertaining to this procedure. A good rule to follow is never treat telangiectasia without written consent from your client’s physician. Regardless of the order, should something go wrong, the technician will probably be named as the responsible party. As a technician, you should consider all of the pros and cons before proceeding with this course of treatment.

Electrolysis is the treatment of choice for localized forms of telangiectasia found on the face and legs. Many technicians who do this procedure use galvanic direct-current electricity of one milliampere or less and will use the smallest flexible needle that will penetrate the skin without bending. After the area is cleansed with 70 percent alcohol or Betadine solution, a sterile needle is inserted into the inner open space or cavity of the blood vessel, this cavity is called a lumen. Free hydrogen is released from the needle, which is wired to serve as the negative-pole electrode, thus obliterating the tiny blood vessel. This procedure is repeated at regular intervals along the length of the vessel. It is best to start where the veins branch out. As you work, you will see the blood leave the vein and it will disappear.

High frequency current can also be used to remove telangiectasia. Great care is needed to guarantee that insertions are accurate and that the current is on for the appropriate amount of time to seal the vessel without causing damage to the epidermis. The high frequency method requires the spacing between insertions to be closer together than those using the direct current method.

Clients should be informed that there may be tiny red eschars (pieces of dead tissue, like a scab) that will form at each entry point. These may last up to several weeks after the procedure. Clients should also be instructed to wash with tepid water if removal is being done on the face (hot water will slightly dilate blood vessels) and not use any harsh cleansers or scrubs as this will further irritate the tissue. Conversely, ice should not be used to control pain as the extreme cold will cause vessels to constrict making it more difficult, if not impossible, to find points of insertion. Controlling spicy foods and alcohol intake is important too because these can dilate vessels. The most important information you can provide to your clients is that telangiectasia may return and those new lesions will have to be treated as they appear.

Check with your particular insurance company to make sure that they will cover this procedure under your malpractice or liability policy. As stated before, be sure to check with your state concerning the laws pertaining to non-physicians performing this procedure. Practicing “medicine without a license” in a state that does not allow us to perform this procedure can mean serious consequences so never work outside your scope of practice or what your state allows. Remember, ignorance of the law is never an excuse!

Telangiectasia of the face and legs can be an unsightly problem for our clients and with the proper training we can control this problem with electrolysis. So the next time you look through your magnifier and see those little red or blue rivers across your client’s face, you can offer them a solution that will remove them safely and effectively, either by you or a physician specializing in treatment of veins.